Search

BACKGROUND The WNT signaling pathway is involved in the regulation of bone homeostasis, and the effect of WNT signaling pathway-related gene (WNT16 and LRP5) polymorphisms on osteoporosis risk among Chinese postmenopausal women is still unknown. Hence, we performed a case-control study to assess the association of WNT signaling pathway-related gene polymorphisms and osteoporosis risk. METHODS A total of 1026 women (515 osteoporosis patients and 511 controls) of postmenopausal age who were randomly sampled from Xi'an 630 Hospital (Shaanxi Province, China) were involved in this study. Seven genetic polymorphisms in WNT16 (rs3779381, rs3801387, rs917727 and rs7776725) and LRP5 (rs2291467, rs11228240 and rs12272917) were selected and genotyped using the Agena MassARRAY iPLEX system. The association of the genetic polymorphisms and osteoporosis risk was assessed by odds ratios and 95% confidence intervals. The multifactor dimensionality reduction (MDR) method was conducted to analyze single nucleotide polymorphism (SNP)-SNP interaction. RESULTS We found that LRP5 polymorphisms (rs2291467, rs11228240 and rs12272917) were significantly associated with a decreased risk of osteoporosis in homozygote, recessive and additive models (p 24 (p

Purpose To investigate the association between urinary complement proteins and renal outcome in biopsy-proven diabetic nephropathy (DN). Methods Untargeted proteomic and Kyoto Encyclopedia of Genes and Genomes (KEGG) functional analyses and targeted proteomic analysis using parallel reaction-monitoring (PRM)-mass spectrometry was performed to determine the abundance of urinary complement proteins in healthy controls, type 2 diabetes mellitus (T2DM) patients, and patients with T2DM and biopsy-proven DN. The abundance of each urinary complement protein was individually included in Cox proportional hazards models for predicting progression to end-stage renal disease (ESRD). Results Untargeted proteomic and functional analysis using the KEGG showed that differentially expressed urinary proteins were primarily associated with the complement and coagulation cascades. Subsequent urinary complement proteins quantification using PRM showed that urinary abundances of C3, C9, and complement factor H (CFAH) correlated negatively with annual estimated glomerular filtration rate (eGFR) decline, while urinary abundances of C5, decay-accelerating factor (DAF), and CD59 correlated positively with annual rate of eGFR decline. Furthermore, higher urinary abundance of CFAH and lower urinary abundance of DAF were independently associated with greater risk of progression to ESRD. Urinary abundance of CFAH and DAF had a larger area under the curve (AUC) than that of eGFR, proteinuria, or any pathological parameter. Moreover, the model that included CFAH or DAF had a larger AUC than that with only clinical or pathological parameters. Conclusion Urinary abundance of complement proteins was significantly associated with ESRD in patients with T2DM and biopsy-proven DN, indicating that therapeutically targeting the complement pathway may alleviate progression of DN.

The recently observed weakly-bound 39Na provides a stringent theoretical constraint on the neutron drip-line. We studied the properties of drip-line nuclei around 39Na with the Hartree-Fock-Bogoliubov method and various Skyrme interactions. We adopted the extended SkM*-ext1 parameterization which can properly describe two-neutron separation energies of oxygen and fluorine isotopes and deformations at the center of the "island of inversion". Systematic calculations of drip lines of O, F, Ne, Na, Mg, and Al isotopes have been performed. We infer that 42Mg is weakly bound and 45Al is less weakly bound. 44Mg and 47Al could be barely existed. We also demonstrated the deformed halo properties of 39Na. Our studies could be valuable for experimental explorations of drip-line nuclei in the forthcoming FRIB and other rare-isotope beam facilities ., Comment: 6 pages, 4 figures, submitted

Si-doped GaN films grown by metal organic chemical vapour deposition have been annealed under different annealing conditions in N2 ambient. The annealed films have been characterized by photoluminescence and high resolution X-ray diffraction. The results show that the rapid thermal annealing (RTA) treatment suppresses the yellow and blue luminescence bands in the annealed Si-doped GaN films. For the sample annealed at 850 °C for 3 min, the yellow and blue band intensities even decreases by approximate one order of magnitude over the as-grown sample. In addition, the densities of the edge and screw threading dislocations in the Si-doped GaN also decrease after the RTA treatment. These facts provide the evidence that the RTA technique can effectively improve the crystalline quality of the Si-GaN films.

A modified multi-objective harmony search algorithm called Niching Multi-objective Harmony Search Algorithm (NMOHSA) is proposed to solve multimodal multi-objective optimization problems. It adopts the neighborhood information to build dynamic harmony memory for maintaining the population diversity. A new memory consideration rule is also applied to prevent the algorithm be trapped into local optimal solution. Moreover, two key parameters, harmony memory consideration rate (HMCR) and pitch adjustment rate (PAR), are dynamically adjusted. Empirical results show that the proposed algorithm performs much better than the other existing multimodal multi-objective algorithms in terms of the solution quality.

MXenes are a rapidly growing family of 2D materials that exhibit a highly versatile structure and composition, allowing for significant tuning of the materials properties. These properties are, however, ultimately limited by the surface terminations, which are typically a mixture of species, including F and O that are inherent to the MXene processing. Other and robust terminations are lacking. Here, we apply high-resolution scanning transmission electron microscopy (STEM), corresponding image simulations and first-principles calculations to investigate the surface terminations on MXenes synthesized from MAX phases through Lewis acidic melts. The results show that atomic Cl terminates the synthesized MXenes, with mere residual presence of other termination species. Furthermore

To establish the experts consensus on the management of delirium in critically ill patients. A special committee was set up by 15 experts from the Chinese Critical Hypothermia-Sedation Therapy Study Group. Each statement was assessed based on the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) principle. Then the Delphi method was adopted by 36 experts to reassess all the statements. (1) Delirium is not only a mental change, but also a clinical syndrome with multiple pathophysiological changes. (2) Delirium is a form of disturbance of consciousness and a manifestation of abnormal brain function. (3) Pain is a common cause of delirium in critically ill patients. Analgesia can reduce the occurrence and development of delirium. (4) Anxiety or depression are important factors for delirium in critically ill patients. (5) The correlation between sedative and analgesic drugs and delirium is uncertain. (6) Pay attention to the relationship between delirium and withdrawal reactions. (7) Pay attention to the relationship between delirium and drug dependence/withdrawal reactions. (8) Sleep disruption can induce delirium. (9) We should be vigilant against potential risk factors for persistent or recurrent delirium. (10) Critically illness related delirium can affect the diagnosis and treatment of primary diseases, and can also be alleviated with the improvement of primary diseases. (11) Acute change of consciousness and attention deficit are necessary for delirium diagnosis. (12) The combined assessment of confusion assessment method for the intensive care unit and intensive care delirium screening checklist can improve the sensitivity of delirium, especially subclinical delirium. (13) Early identification and intervention of subclinical delirium can reduce its risk of clinical delirium. (14) Daily assessment is helpful for early detection of delirium. (15) Hopoactive delirium and mixed delirium are common and should be emphasized. (16) Delirium may be accompanied by changes in electroencephalogram. Bedside electroencephalogram monitoring should be used in the ICU if conditions warrant. (17) Pay attention to differential diagnosis of delirium and dementia/depression. (18) Pay attention to the role of rapid delirium screening method in delirium management. (19) Assessment of the severity of delirium is an essential part of the diagnosis of delirium. (20) The key to the management of delirium is etiological treatment. (21) Improving environmental factors and making patient comfort can help reduce delirium. (22) Early exercise can reduce the incidence of delirium and shorten the duration of delirium. (23) Communication with patients should be emphasized and strengthened. Family members participation can help reduce the incidence of delirium and promote the recovery of delirium. (24) Pay attention to the role of sleep management in the prevention and treatment of delirium. (25) Dexmedetomidine can shorten the duration of hyperactive delirium or prevent delirium. (26) When using antipsychotics to treat delirium, we should be alert to its effect on the heart rhythm. (27) Delirium management should pay attention to brain functional exercise. (28) Compared with non-critically illness related delirium, the relief of critically illness related delirium will not accomplished at one stroke. (29) Multiple management strategies such as ABCDEF, eCASH and ESCAPE are helpful to prevent and treat delirium and improve the prognosis of critically ill patients. (30) Shortening the duration of delirium can reduce the occurrence of long-term cognitive impairment. (31) Multidisciplinary cooperation and continuous quality improvement can improve delirium management. Consensus can promote delirium management in critically ill patients, optimize analgesia and sedation therapy, and even affect prognosis.谵妄是ICU中常见的一种急性临床综合征，可导致患者病死率增加，机械通气时间和住院时间延长，引起长期的认知功能障碍，增加医疗费用，严重影响患者的预后。为规范重症患者的谵妄管理，由中国冷静治疗研究组根据国内外最新文献资料和多年来的应用推广经验，组织相关重症医学专家在充分讨论和沟通基础上制定了"重症患者谵妄管理专家共识"。旨在改进重症患者的谵妄管理，优化镇痛镇静治疗，改善患者的预后。.

Background Rho kinase inhibitor Fasudil is effective in the treatment of EAE, but its narrow safety window, lower bioavailability limit the clinical use. Hydroxyfasudil, active metabolite of Fasudil in vivo, exhibits higher biological activity and longer half-period. Objective To observe the therapeutic potential of Hydroxyfasudil in EAE, and explore its possible mechanisms. Material and methods The effects of Hydroxyfasudil on cell viability. We further explored therapeutic effect in EAE model. Female C57BL/6 mice were immunized with myelin oligodendrocyte glycoprotein peptides (MOG35-55), which were divided into EAE group, Hydroxyfasudil group. Hydroxyfasudil was injected intraperitoneally (40 mg/kg/day) on day 3 post immunization. The injection of saline was set up as control in a similar manner. Results Hydroxyfasudil was well tolerant in vitro. Hydroxyfasudil delayed the clinical onset and suppressed the severity of EAE. Demyelination and cell infiltration in spinal cords of Hydroxyfasudil group were significantly decreased. Flow cytometry analysis showed that Hydroxyfasudil reduced CD4+IFN-γ+ and CD4+IL-17+ but increased CD4+CD25+ T cells. Hydroxyfasudil decreased inflammatory cytokine, chemokine and inhibited NF-κB, COX-2, iNOS. According to RT-PCR analysis, Hydroxyfasudil suppressed iNOS, CD68 and TNF-α, while enhanced Arg-1, IL-4 and TGF-β. Conclusion Hydroxyfasudil should be a potential approach for EAE through immunomodulation, anti-inflammatory effects, the transformation of M1 type macrophages to M2, preventing the infiltration of inflammatory cells into CNS. (NNSF of China 81473577, Shanxi Scholarship Council of China 2014-7, 2011 Cultivation Project of Shanxi University of TCM 2011PY-1. Ma and Xiao are corresponding authors).

microRNA (miRNA) and piwi-interacting RNA (piRNA) are two classes small non-coding regulatory RNAs that play crucial roles in multiple biological processes such as spermatogenesis. However, there are no published studies on conjoint analysis of miRNA and piRNA profiles among cattle, yak and their interspecies (the dzo) using sequencing technology. Next-generation sequencing technology was used to profile miRNAs and piRNAs among those three ruminants to elucidate their functions. A total of 119, 14 and six differentially expressed miRNAs were obtained in cattle vs. dzo, cattle vs. yak and yak vs. dzo comparison groups, while there were 873, 1,065 and 1,158 differentially expressed piRNAs in those three comparison groups. The expression of three miRNAs was validated in the three ruminants, and the results suggested that the miRNA expression profiles data could represent actual miRNA expression levels. Moreover, the putative targets of differentially expressed miRNAs were predicted by their own genome, it is worth to note that both the cattle and yak genome were used for dzo, then the targets were subjected to GO enrichment and KEGG pathway analysis, revealing the likely roles for these differentially expressed miRNAs in spermatogenesis. In conclusion, this study provided a useful resource for further elucidation of the miRNAs and piRNAs regulatory roles in spermatogenesis. It may also facilitate the development of therapeutic strategies for dzo reproduction research.

To establish the experts consensus on the right heart function management in critically ill patients. The panel of consensus was composed of 30 experts in critical care medicine who are all members of Critical Hemodynamic Therapy Collaboration Group (CHTC Group). Each statement was assessed based on the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) principle. Then the Delphi method was adopted by 52 experts to reassess all the statements. (1) Right heart function is prone to be affected in critically illness, which will result in a auto-exaggerated vicious cycle. (2) Right heart function management is a key step of the hemodynamic therapy in critically ill patients. (3) Fluid resuscitation means the process of fluid therapy through rapid adjustment of intravascular volume aiming to improve tissue perfusion. Reversed fluid resuscitation means reducing volume. (4) The right ventricle afterload should be taken into consideration when using stroke volume variation (SVV) or pulse pressure variation (PPV) to assess fluid responsiveness.(5)Volume overload alone could lead to septal displacement and damage the diastolic function of the left ventricle. (6) The Starling curve of the right ventricle is not the same as the one applied to the left ventricle,the judgement of the different states for the right ventricle is the key of volume management. (7) The alteration of right heart function has its own characteristics, volume assessment and adjustment is an important part of the treatment of right ventricular dysfunction (8) Right ventricular enlargement is the prerequisite for increased cardiac output during reversed fluid resuscitation; Nonetheless, right heart enlargement does not mandate reversed fluid resuscitation.(9)Increased pulmonary vascular resistance induced by a variety of factors could affect right heart function by obstructing the blood flow. (10) When pulmonary hypertension was detected in clinical scenario, the differentiation of critical care-related pulmonary hypertension should be a priority. (11) Attention should be paid to the change of right heart function before and after implementation of mechanical ventilation and adjustment of ventilator parameter. (12) The pulmonary arterial pressure should be monitored timingly when dealing with critical care-related pulmonary hypertension accompanied with circulatory failure.(13) The elevation of pulmonary aterial pressure should be taken into account in critical patients with acute right heart dysfunction. (14) Prone position ventilation is an important measure to reduce pulmonary vascular resistance when treating acute respiratory distress syndrome patients accompanied with acute cor pulmonale. (15) Attention should be paid to right ventricle-pulmonary artery coupling during the management of right heart function. (16) Right ventricular diastolic function is more prone to be affected in critically ill patients, the application of critical ultrasound is more conducive to quantitative assessment of right ventricular diastolic function. (17) As one of the parameters to assess the filling pressure of right heart, central venous pressure can be used to assess right heart diastolic function. (18). The early and prominent manifestation of non-focal cardiac tamponade is right ventricular diastolic involvement, the elevated right atrial pressure should be noticed. (19) The effect of increased intrathoracic pressure on right heart diastolic function should be valued. (20) Ttricuspid annular plane systolic excursion (TAPSE) is an important parameter that reflects right ventricular systolic function, and it is recommended as a general indicator of critically ill patient. (21) Circulation management with right heart protection as the core strategy is the key point of the treatment of acute respiratory distress syndrome. (22) Right heart function involvement after cardiac surgery is very common and should be highly valued. (23) Right ventricular dysfunction should not be considered as a routine excuse for maintaining higher central venous pressure. (24) When left ventricular dilation, attention should be paid to the effect of left ventricle on right ventricular diastolic function. (25) The impact of left ventricular function should be excluded when the contractility of the right ventricle is decreased. (26) When the right heart load increases acutely, the shunt between the left and right heart should be monitored. (27) Attention should be paid to the increase of central venous pressure caused by right ventricular dysfunction and its influence on microcirculation blood flow. (28) When the vasoactive drugs was used to reduce the pressure of pulmonary circulation, different effects on pulmonary and systemic circulation should be evaluated. (29) Right atrial pressure is an important factor affecting venous return. Attention should be paid to the influence of the pressure composition of the right atrium on the venous return. (30) Attention should be paid to the role of the right ventricle in the acute pulmonary edema. (31) Monitoring the difference between the mean systemic filling pressure and the right atrial pressure is helpful to determine whether the infusion increases the venous return. (32) Venous return resistance is often considered to be a insignificant factor that affects venous return, but attention should be paid to the effect of the specific pathophysiological status, such as intrathoracic hypertension, intra-abdominal hypertension and so on. Consensus can promote right heart function management in critically ill patients, optimize hemodynamic therapy, and even affect prognosis.

Along with increasing speed and acceleration of numerically controlled machine tools, the influence of thermal dynamics characteristics on operating accuracy becomes more and more important. Improvement of thermal dynamics characteristics has turned out to be one of the crucial problems to develop machine tool of high performance. The positioning error of a feed drive system, mostly caused by the thermal deformation of a ball screw shaft, can directly affect the working accuracy of the machine tool. In this study, we applied the computational approach using the finite element method (FEM) to simulate the thermal expansion process for estimating the deformation of the ball screw system. In the numerical analysis, the deformation of the ball screw shaft and nut was modeled via a linear elasticity approach along with the assumption that the material was elastic, homogeneous, and isotropic. To model the reciprocating motions of the nut at a speed of 60m/min respecting to the screw shaft, we utilized the three-dimensional unsteady heat conduction equation with the frictional heat from the sources of the ball screw shaft, nut and bearings to calculate the temperature distributions for determining the temperature rises and axial thermal deformations in a ball screw shaft under operating situations. Simulations were conducted to explore the connection between the temperature increase of nut and the thermal deformation of the ball screw drive system, revealing the need of a compensation scheme for thermal error to improve the operating accuracy of machine tools.

Spectator fragments resulting from relativistic heavy ion collisions, consisting of single protons and neutrons along with groups of stable nuclear fragments up to nitrogen $(Z=7)$, are measured in PHOBOS. These fragments are observed in Au+Au $(\sqrt{{s}_{{}_{NN}}}=19.6\phantom{\rule{0.16em}{0ex}}\mathrm{GeV})$ and Cu+Cu (22.4 GeV) collisions at high pseudorapidity $(\ensuremath{\eta})$. The dominant multiply-charged fragment is the tightly bound helium $(\ensuremath{\alpha})$, with lithium, beryllium, and boron all clearly seen as a function of collision centrality and pseudorapidity. We observe that in Cu+Cu collisions, it becomes much more favorable for the $\ensuremath{\alpha}$ fragments to be released than lithium. The yields of fragments approximately scale with the number of spectator nucleons, independent of the colliding ion. The shapes of the pseudorapidity distributions of fragments indicate that the average deflection of the fragments away from the beam direction increases for more central collisions. A detailed comparison of the shapes for $\ensuremath{\alpha}$ and lithium fragments indicates that the centrality dependence of the deflections favors a scaling with the number of participants in the collision.

To study the perioperative management and surgical treatment of patients with neurosurgical critical diseases and thrombocytopenia.Eleven patients with the diagnosis of neurosurgical critical diseases and thrombocytopenia who received surgical treatment in Department of Neurosurgery, Peking Union Medical College Hospital from 2010 to 2015 were reviewed retrospectively. All eleven patients received platelet transfusions preoperatively. The safety and efficacy of surgical treatment were analyzed by GOS score at 6 months after operations.Platelet counts of six patients who received minimally invasive surgery reached 80×10(9) /L by platelet transfusions preoperatively. Platelet counts of five patients who received Craniotomy and ventriculoperitoneal shunt reached 100×10(9) /L by platelet transfusions preoperatively. Eight patients received platelet transfusions postoperatively according to a low platelet count 24 hours after operations. Two patients died after surgery and one died after discharge. All other eight survival patients got well recovery with an average GOS score of 4.5 at six months after operations.Patients with neurosurgical critical diseases and thrombocytopenia could receive surgical treatment in collaboration with relative departments.

The purpose of this study was to evaluate the significance of echocardiography for the prognosis of acute left cardiac dysfunction in critically ill patients.A prospective cohort study was conducted in patients with acute left cardiac dysfunction in the Department of Critical Care Medicine, Peking Union Medical College Hospital from June 2013 to June 2014. Patients were divided into four groups according to the echocardiographic manifestation, including biventricular failure, left ventricular failure, coronary related segmental movement disorder, non-coronary related segmental movement disorder. All patients were treated with standard hemodynamic therapy. The duration of cardiotonic drug use, the period of mechanical ventilation, the length of ICU stay and 28-day mortality rate were recorded.A total of 132 patients were retrospectively enrolled in this study. The incidence of coronary heart disease in the coronary related segmental movement disorder group (88.0%, 22/25) was higher than that in the other three groups (P0.001), while other general clinical information between groups at baseline was comparable (P0.05). Sepsis or septic shock was the main cause of acute left cardiac systolic dysfunction. The 28-day mortality rate in biventricular failure group was 21.05%, 19.05% in left ventricular failure group, 20.00% in coronary related segmental movement disorder group, and 1/10 in non-coronary related segmental movement disorder group (P0.001). However, the duration of cardiotonic drug use, the period of mechanical ventilation, and the length of ICU stay were similar in all groups (P0.05) .In biventricular failure group, previous history of left ventricular diastolic dysfunction significantly worsened the 28-day mortality rate (5/7, P0.001). while diastolic dysfunction did not affect cardiotonic drug use, the period of mechanical ventilation and length of ICU stay(P0.05).The different echocardiographic features of acute left cardiac systolic dysfunction in critically ill patients predict the different prognosis. We need to setup an evaluation system including left cardiac systolic/diastolic function and right cardiac function, which may improve the process of workflow.